Pallimed.orgI have previously highlighted the excellent palliative care blog, Pallimed.org [Disclosure: Tom Quinn, Editor of YaleCares, is a former regular contributor to Pallimed]. I would like to point out some recent excellent blogs on the Arts & Humanities section of Pallimed. One of these is The Death of Mr. Hooper on Sesame Street. It includes an audio interview with the creator of Big Bird. Another is Eco-Friendly Burial. Who knew?Learn More >>

palliativecaregr.blogspot.comPalliative Care Grand Rounds is a monthly review of palliative care blogs. A different blogger hosts it each month.Learn More >>

Integrative OncologyA collection of short reviews from a monthly column by Barrie Cassileth, PhD in Oncology. The most recent review is on Oxygen Therapies. (free registration required to access articles)Learn More >>

ElsewhereApril 27 - May 4, 2010 and November 9-15, 2010Program in Palliative Care Education and Practice. Harvard Medical School, Boston. Perhaps the premier course for physicians and nurses in palliative care.Learn More >>

Online

Pain and Addiction 101A series of courses at Emerging Solutions in Pain. (CME, CPE, CNE)Learn More >>

January 2010 Volume 3 · No 11

Does Morphine Encourage Cancer Growth?

Thomas Quinn, APRN, MSN

Some recent scary headlines in the lay press hyped a very preliminary study in lung cancer cell lines, suggesting that use of morphine (or other opioids) in advanced cancer patients may hasten death, and that methylnaltrexone, a peripherally acting opioid antagonist, may retard cancer growth. The news reports cite "growing clinical evidence" of this phenomenon. Unfortunately, the "clinical evidence" cited is barely tenuous and the laboratory studies are very preliminary.

The news reports were based on a press release by the University of Chicago press office. It should be noted that methylnaltrexone, which is currently indicated only for opioid-induced constipation in advanced cancer patients, was developed at the University of Chicago and licensed to a pharmaceutical company.

The press release is based on a presentation at a scientific meeting. Even early research findings by well-regarded scientists must be subjected to peer review through publication in reputable scientific journals; this report is yet to be published.

The research was initiated after a small number of patients in a methylnaltrexone study lived longer than expected. Similarly, a very small number of patients with advanced cancer in an intrathecal analgesic study lived a little longer than expected (but did not reach statistical significance, and it was not a study end-point).

Three small, single-institution clinical studies are mentioned (two of them at the same institution in Ireland). Longevity related to opioid use was not a study question in any of these studies. There are multiple other factors that could have contributed to any perceived survival advantage.

There are several small studies which show that well-managed pain (using aggressive opioid treatment) in end-stage disease does not shorten life and may have a slight survival advantage in some cases (these studies did not address the direct affect of opioids on tumor growth, which is the presumed reason for the observed survival effect).

Opioid analgesics have a long and well-documented track record of relieving pain and dyspnea associated with advanced cancer, reducing suffering, and improving quality of life.

Clinical practice in any arena should not be changed based on the findings of a single study, even one that is well-designed and conducted. The findings from these studies are speculative. From a research perspective they raise interesting questions that suggest hypotheses and form the basis for future laboratory research. Based on results of those future studies, clinical trials can then be designed.

There is some fascinating science at work in this, and it will be prudent to follow its progress in the coming years. However, it would be imprudent, at best, to change current pain management practices with opioid analgesics based on this report. Patients and clinicians need to have the news reports put in perspective.

Bober SL. Out in the open: Addressing Sexual Needs after Cancer. Cancer Journal 2009; 15(1):13-14.This is an editorial by the Guest Editor of a special issue of Cancer Journal (2009 Jan-Feb;15(1)] that has several articles on sexuality. Dr. Bober will be the keynote speaker for the 4th Annual Yale Survivorship Symposium, April 21, 2010Read More >>